rffi-Division of Transportation System DevelopmentNorthwest Region - Eau Claire Office718 W. Clairemont Ave.Eau Claire. WI 54701-5108

Scott Walker, GovernorMark Gottlieb, PE, Secretary

lnternet: www. dot.wisconsin.gov

'l'elephone: (7 I 5) 836-3905Toll Free: (800) 991-5285

FAX:(715) 836-2807E-mail tammy.ricksecker@dot.wi. gov

November 23,2011

KENDALL KLEVGARD5788 STATE ROAD BBMONDOVT Wt 54755

Subject: Connection Permit #0679201 1

SESW Sec I l, T23N Rl 1WSTH BB, Buffolo County

Deor Mr Klevgord:

Enclosed is the required connection permit for chonging the use ond troffic volumes ofyour drivewoy. This permit olso outhorizes limited work on the highwoy right of woy tomointoin the drivewoy ond culvert qnd to trim vegetotion or grode slopes to improvevisibility. All groding oreos sholl be restored io prevent erosion. Pleose review, sign ondrelurn o copv of fhe permil in the enclosed prepoid envelope.

The drivewqy moy be Widened to o moximum top width of 35 feet. lf you ore wideningthe drivewoy. the lengih of the culvert pipe should be extended so thot the opron endwolls con be properly ottoched ond the 4:lside slopes ore properly constructed. Refer tothe enclosed detoils.

The lond owner is responsible for oll costs if odditionol drivewoy/highwoy improvementsore required if this connection interferes wiih highwoy troffic ond becomes o sofety issue.

Contoct ond coordinoiion with Digoers Hotline ond ony utility is the responsibility of thelondowners. lf you hove qny questions, pleose contoct me directly of 7,|5-836-3905.

Sincerely,

"f /1rJ a,r,t'h'.1* i{ uka-t e't o "4

JTommy RickseckerAccess Monogement CoordinotorNW Region - Eou Cloire Office

Enclosures: Rurql Drivewoy Deioil SheetsCulvert Requirements

Cc: Poul Vqn Eijl, Buffolo County ZoningBob Plqtteter, Buffolo County Potrol SuperiniendentBrendo McNollon, WisDOT Moinlenonce Coordinotor

ApF'1"f,*,|*lTtt"lrliir'ffiffifr,,iT{'f" F'iillfti {.;{iil*f'+l*{:1";ir1;r1r1 I rt} $T,*,T"1* T[ .ti]'$l{,, Hn'i}Fil',#,*,i{\"ivisco n$ ii1 De ps rlrr ent cf -l- ra n spori3il6 11 (\,/VisDC]- )

DTJ504 4i2009 s 8607i2iWis Ststs &Ch.Trans?31 Wis.Acrn.Code', This form is an application for permissicn for a STFI Connecit,rn lf e pproved, the

permit doe s r;*,t create a rignt;:tl:rr;6n** or f,,*se$s e;;rs*:fficltt r'cr the prcpei"tylf ihe proper-i1r has airy legal resiricticns iiiat r:roiribit acc*ss io a state 'irunk lrighr.n/a)i I f g(STl-l), WiSDOT carrnoi acprorre a Sl-l-i ccnnection p*i-nit for iire pfCIpefiy.

o Ple$se tirp'a *:r prir,:t r:*ertly in irri<" Fili out the requirerJ inf.rrrnaiion on trr*€h siele* I SH $ raii crai,e L'vr s4701of ihis fornr per the irisiructions One form is i"e qriired per conricciicir. For'moreinfortration. visii: wwrr'i.dot.wiscorrsinSoyib.usin*lsirulesinropedv-i:ernrirs.lrim

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fl 1. Appiicar:t Name anc i\liailing Acldress - StreeriPO Box City Siare, ZIP Cccletl*3il

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! 2. Frcoe,r*y O',',,ner hlanre i A.Cciress ilf not apciican'i)I

li Noi Properly Oi,'rner. Reason for r\oolicarion

!I,l loLvrr 7 Side cf ihe l-irglr'"vayi

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9, Fire or Street Nunri:er ilf anplicaoiei

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SE Qr-rarier, of tire S\rV QL:arter, Seciion 1"i, Tawn 23 Nortli. Range 11 West10 Nlanre ci'hjea;"est SiCe RoeC froni Lccaticn

CROSS RCAD

f Conslruci NlelvPSr Arier trxtsltngL_l Nerl]ove t.xtsitnclf Permit E:<:siirrg

Rural * AgriculiuralPublic RoadTraii or Traii Crossing

Seasonal il tct-10oti1-50 f.l over 100051- 1 00

Disiance end Direition fr^onr Sicie Roaa

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f i Flor,v far is ilre localicir from therearest'ion-sicie road connectionor-r ihe sanre nrghway? 300

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1 4. P:"oposed lliictn: 35' i\."ia:<

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'4t[$ ar'eas elistur"b nlLesii he r'*$.t*!"*cl vufii.h t,xii:rs*i$.girai$s s*e ancii li:q"tf*:h t* pg'ev*ir'[: *r.r_:*i*ru,'**rita*'ling *'i iJiggers l{ot![ne isi tl"l* r,s$t],.]n6iil"1ii[t1,r *l'th**erffitil$s.

13 Pronosed Use lCheck one * See iirsrrr":ciior-'s for caiecory descriprionl 16. Prcposed T;'ips Per Day rChecx cne)

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A connectrons have rcstricticns which k The aoplicac:3f;rms that all lilf.r.*a{on p.ovided on ard 3lbm:ttedand ri'ed-in on :his appricarion """n ;l#":il""j::1il"jf'j"'""Jjiji: :,jl*,:l:.^t?j:j^.::j.1"j..ill.:illl*;11:Y:$::::::.-'.",1 _.:supqtereqar .,olisions sup€rimpos; ":i:i:11;:;!i-iii*;;i"1i9; [:i?ii1*i:::il:5J,,tr1;::'J::e?g;:i'::,:ffi"",:i:':: *by WisDOT. The aooicanl snall .e resoorsble ior ccmplying r/th rrese ' _ / /lrestrlcto.salong'uLhrheconsr-rctronanjr,arnlenancecfir"eccr-ecior /t /--r/ fr //:Jillr::Tl;':"tixtt jr:ji;::x*j*,i:l-#,:r"*;:xl!/Y(A(/I::1--e;4-14utaws. codes, rures fegr'rlr ons o(,r?nces arc Femt requrenenls "1 I'3!lI Yllll .r?'l! zec,Hepresenlatnre: ru e

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other ju risd icticna I ageicies. rle aiteration orifr. i",rn rrv iri-rppr,"r. . lf compuler-filled' Siusf script Fcntlprohibited. Under s. 86 073 Wisconsin Staiuies. \ JisOOT's permit arriai ot 715,495,9226revocation rral be aFpeated* ".- -, *-:*--lE-Tetk*:rla"e e

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, i-] Tenrporary pefmit. E;<piration date.

Cc-user natre

11i21i?A1 1

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F i le 06-Cr38-iv'i0 i,"t-i(ler;g arc

APPLICATION/PERMIT FOR CONNEGTION TO STATE TRUNK HIGHWAYCode

Wisconsin Department of Transportation lWisDOT)DT1504 412009 s, 86.07(2) Wis. Stats. & Ch. Trans 231 Wrs, Adm

This form is an application for permission for a STH Connection. lf approved, thepermit does not create a right of access or access easement for the property.lf the property has any legal restrictions that prohibit access to a state trunk highway(STH), WisDOT cannot approve a STH connection permit for the property.Please type or print neatly in ink. Fill out the required information on both sidesof this form per the instructions. One form is required per connection. For moreinformation, visit: www.dot.wisconsin.qov/business/rules/property-permits.htmPlease provide a copv of the deed with all

lu9zt9ofr-E'at/XPoz3

DocumenttoentificationNumoer: i6792011

718 W Clairemont AveEau Claire Wl 5470171 5-836-3905

z!eq!EE

1. Applicant Name and Mailing Address - StreeVPO Box, City, State, ZIP Code

KENDALL KLEVGARD5788 STATE ROAD 88MONDOVI WI

2. Property Owner Name / Address (lf not applicant)

3. lf Not Proper$ Owner, Reason for Application

zI*=69J!4=YTFOCt lLuzzoo

4. Highway Numbe(s)

STH 885. County

BUFFALO

6. ncity Ivittage Erownof: GILMANTON

7. Side of the Highway

n uortn ! South X East n West

8. Located within the

SE Quarter, of the SW Quarter, Section 11, Town 23 North, Range 11 West9. Fire or Street Number (lf applicable)

5788 STATE RD 88

10. Name of Nearest Side Road from

CROSS ROAD

Location Distance and Direction from Side Road

3010 s(Feet or Miles) (N, S, E, W)

11. How far is the location from thenearest non-side road connectionon the same highway? 30q

(Feet or Miles)

Log Mile or Reference Point (Filled in by WiSDOT):

tuo->zFOzFo<tr=oIruOzrLzZo-o

12. Proposed Activity(Check one)

n Construct NewEl Rtter Existingfl Remove Existingfl Permit Existing

13. Proposed Use (Check one - See instructions for category description)

n Urban - Commercial/lndustrial I Rural - Agriculturalfl Urban - Residential I puOtic Road[l Rural - Commercial/lndustrial n Trail or Trail Crossingfl Rural- Residentialls this a change of the existing use (lf applicable)? X Yes f] ruo

16. Proposed Trips Per Day (Check one)

f] seasonal f] 101-1ooofl t -so I over 1000E st-tooPeak hour traffic count:

14. ProposedWidth: 35'Max | 1S. Proposed Surface: gravel QUESTIONS 17-27 on BACK PAGE

All connections have restrictions, which include the information preprintedand filled-in on this application along with any conditions, covenants,supplemental provisions, superimposed notes, and detail drawings addedby WisDOT, The applicant shall be responsible for complying with theserestrictions along with the construction and maintenance of the connection.It is fufther understood that WisDOT's approval is subject to applicant's fullcompliance with relevant state statutes and administrative rules, plus anylaws, codes, rules, regulations, ordinances and permit requirements ofother jurisdictional agencies. The alteration of this form by the applicant isprohibited. Under s. 86.073 Wisconsin Statutes, WISDOT's permit denial orrevocation may be appealed.

The applicant affirms that all information provided on and submittedwith this form is correct and complete. Providing incorrect or

(Property Owner or Authorized Repre(lf Computer-filled, Brush Script Font)

715-495-9226(Area Code and Telephone #) (E-mail address if available)

FOR OFFICIAL WISDOT USE ONLY - DO NOT WRITE BELOW THIS LINE

X THE FOLLoWING SUPPLEMENTAL PRoVISIoNS APPLY. An 18" x 40''corrugated culvert with 4:1 apron endwalls isrequired. Cleaning and inspection of the existing culvert fordeterioration is required if extending to match 18" x 40'.. lt is the responsibility of the landowner to maintain anyerosion or tracking from the driveway that may impede thehighway and drainage ditch.. This permit authorizes work on highway right-of-way to trimtrees and cut back slope to attain visibility to and from thedriveway. All areas disturb must be restored with topsoil,grass see and mulch to prevent erosion..Contacting of Diggers Hotline is the responsibility of thepermitee.

Permit APPROVED Onrs pERMrr rs REVocABLE)Permit DENIEDApplication DISMISSED

XunxTanaaaq ?aeufun 11n1tzo11(WisDOT Authorized Representative) (Date)(lf Computer-filled, Brush Script Font)

f] Temporary permit. Expiration date:

fl ttris permit voids / replaces permit #

.- SharedU connectionCo-user name:

Related oermit #File: 06-088-M01 4-Klevgard

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